Care Specialist

SILAC Insurance Company•Salt Lake City, UT

6d•Onsite

About The Position

The Care Specialist determines claims eligibility and manages cost-effective care planning for Long-Term Care (LTC) policyowners. The role coordinates with other LTC Department staff to administer claims accurately, communicate policy language clearly, and provide personalized customer service. Care Specialists represent the company’s mission and values while building trustworthy, lasting relationships with customers, care providers, agents, and business partners. The position is full-time and in-office, Monday through Friday, for 40 hours per week. The schedule starts between 6:00 AM and 9:00 AM Mountain Time. Starting pay is $21.75 per hour. The Care Specialist reports to the L&H Eligibility Manager.

Requirements

High school diploma, GED, or a combination of education, professional training, or work experience demonstrating the ability to perform the job.
Ability to accurately assess policyowner needs and create individualized care plans.
Experience communicating professionally, patiently, and clearly in speech and writing.
Ability to research and logically consider details from multiple sources and synthesize them to support a conclusion.
Experience using PC applications such as MS Word, Excel, Teams, and Outlook.
Detail-oriented, with the ability to complete tasks accurately and in a timely manner.
Demonstrated ability to work independently, manage workload, and meet time-sensitive deadlines.

Nice To Haves

Geriatric client experience.
Long-Term Care, disability, or other insurance claims experience.
Insurance experience in cost containment.
Knowledge of state regulations and requirements, Anti-Money Laundering procedures, and identifying potential fraud or elderly abuse situations.

Responsibilities

Review relevant documents, including care plans, assessments, and medical records, to determine eligibility for benefits.
Conduct reassessments as needed to determine continued eligibility.
Contribute to improvements in written care-coordination processes, procedures, and guidelines, including improvements to efficiency through better methods and automated systems.
Communicate and explain care planning to customers, care providers, agents, and SILAC staff, supporting explanations with evidence from provider records and functional assessments.
Coordinate and communicate with SILAC leadership, medical consultants, auditors, and other industry professionals.
Assist with tasks and projects such as claim appeals, legal disputes, and revisions of forms and documents.
Perform other work or projects as directed by the L&H Eligibility Manager.